exam 2 Flashcards by britt rank

[A/A+B]/[C/C+D]

Measures of Association

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Incidence in Exposed divided by Incidence in Unexposed

Relative Risk

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If Relative Risk = __ exposure is NOT associated with disease

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If Relative Risk ___ exposure is associated with an increased risk of disease

> 1

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If Relative Risk ___exposure is associated with a decreased risk of disease (i.e. is protective against the development of the disease)

< 1

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Measure of association between frequency of exposure and frequency of outcome used in case-control or cross sectional studies.

Odds Ratio

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OR ___ means a positive association between risk factor and health condition

> 1

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OR ___ means a negative association; risk factor serves as a protective factor

< 1

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relative risk or odds ratio is used for COHORT

relative risk

odds ratio

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relative risk or odds ratio is used for CASE CONTROL

odds ratio

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relative risk or odds ratio is used for CROSS SECTIONAL

odds ratio

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relative risk or odds ratio is used for ECOLOGICAL

neither

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Serve as an indicator of progress towards achieving HP objectives and goals

HP 2020 Foundation Health Measures

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Preventing Drug Abuse & Excessive Alcohol Use
Tobacco Free Living
Healthy Eating
Active Living
Injury & Violence Free Living
Reproductive & Sexual Health
Mental & Emotional Well-Being

National Prevention Strategy Priorities

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increase the # of Americans that are healthy at every stage of life

National Prevention Strategy overall goal

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highlights health disparities and inequalities across a wide range of diseases, behavioral risk factors, environmental exposures, social determinants, and health-care access by sex, race and ethnicity, income, education, disability status and other social characteristics

CDC Health Disparities & Inequalities Report

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The Surgeon General’s Call to Action to Promote Walking and Walkable Communities

step it up

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the study of the function and effect of single genes that are inherited by children from their parents.

Genetics

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In contrast to genetics this involves the study of ALL of a person’s genes

including the interaction of a person’s genes with the environment & other factors

Genomics

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Long term & global project (project draft: 1988-2003) to map and sequence entire human genome; involved scientists around the world

Mapped the approximately 22,000-30,000 genes that make up part of the human genome

All humans are 99.9% identical at the DNA level
About 95% of the genome regulates DNA

Human Genome Project

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Occupation ( assumes families often work in same trade)

Radon from soil (assumes family lives in same vicinity)

Religious preferences

Lead in paint (assumes family grew up in same home)

Environmental exposure, such as second hand smoke

Clustering of “Non-Genetic” Exposures in Families

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The National Coalition of Health Professional Education in Genetics (NCHPEG) identified the following “clues” that would function as red flags:

Multiple family members affected

Known ethnic predisposition to certain genetic disorders?

Close biologic relationship to parents with same condition?

Condition occurs in the gender that is least expected, or the onset is at an earlier age than expected?

Determining if disease risk is related to genetics

RED FLAGS

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may be helpful in determining whether a disease is associated primarily by genetic or environmental factors

Migrant studies

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Not to act is to make a decision!

Use human rights law to frame the laws guiding translating genomics into healthcare

The community must be consulted

Response must be based on good science

Policies must have global mechanisms

Ethical Principles: translation of Genomics in Health Care

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Helpful for setting priorities & identifying hazards Hypothesis formulation, possibly for a new occupational risk

Descriptive study designs

(aka etiologic studies) to examine causality & the natural history of the disease Such as, what are the affects of low-level exposures? What are the relationships between exposure & affect? Retrospective cohort designs are often used (next slide)

Analytic study designs

Various end points are used to study the effects of occupational exposures. For example, if you want to study the effects of asbestos exposure in ship-yard workers on the development of mesothelioma What outcome data could be used? Morbidity: self-reports of symptoms and results of clinical examinations possibly related to asbestos Mortality: comparison of mortality rates of exposed workers with nonexposed workers in the same industry.

Retrospective Cohort Studies

Defined as competing with the true association between an exposure & an outcome of interest because of the influence of a 3rd variable (which was not considered in the study design or analysis)

Confounding Factors

Refers to systematic departures of measures from their true measure Considered an error in design, methodology or analysis One example is the Healthy Worker Effect (next PPT slide)

Bias

Observation that employed populations tend to have a lower mortality experience than the general population. (In a general population both employed and non-employed persons are represented; but unemployed may be those with poorer health. Compare to an occupational study population in which only those who are healthy enough to work are included.)

The Healthy Worker Effect

Defined as the lowest dose at which a particular response may occur. Yet, it is unclear whether these low doses are sufficient to produce any health responses

Threshold

the belief that low level exposure may even protect against high level exposure

Hormesis

is a sigmoid shaped curve with flat bottom indicating that as dose increases initially there is little effect. Then when threshold is achieved there is a sharp rise in the curve. Eventually there is another linear phase in which an increase in dose does not show a remarkable increase response. How used? If this S shaped curve is seen, then there is likely a causal effect of the exposure on the health outcome.

A dose-response curve

The time period between initial exposure and a measurable response Latency can range from seconds

Latency

Refers to a situation in which the combined effect of several exposures is greater than the sum of the individual effects.

Synergism

-a case of unnecessary disease, unnecessary disability, or untimely death whose occurrence is a warning signal that the quality of preventive or medical care may need to be improved

Sentinel health event

is the study of these environmental exposures that can change the DNA. Epigenetics is useful in helping to predict disease Studies heritable changes caused by the activation and deactivation of genes; turning them on or off

Epigenetics

The basic science applied to understanding the health effects associated with serious chemical exposures

toxicology

A model used to explain the etiology of infectious diseases. Recognizes three major factors in the pathogenesis of disease: agent, host, and environment.

Epidemiologic Triangle

Once an agent infects the host, the degree and severity of the infection will depend on the host’s ability to fight off the infectious agent

host

Generally make it harder for an agent to penetrate & cause disease Examples include skin, mucosal surfaces, tears, saliva, gastric juices, and general immunity

Nonspecific Defense Mechanisms (not specific to a particular agent

Results from an infection by the agent. Example: A patient develops long-term immunity to measles because of a naturally acquired infection.

active or natural immunity

Results from an injection with a vaccine that stimulates antibody production in the host.

Artificial, active or vaccine-induced immunity

Immunity of a population, group, or community against an infectious disease when a large proportion (not necessarily all) of individuals are already immune either through vaccinations or prior infection.

Herd Immunity

Defined as the proportion of a group that experiences the outcome under study over a given period. where new cases are determined. Sometimes defined as the number of people at risk in whom a certain illness develops divided by the total number of people at risk Used when the occurrence of disease among a population at risk increases greatly over a short period of time.

Attack Rate

This is not a true rate but a proportion formed by the number of deaths caused by a disease among those who have the disease during a time interval. Generally used for a virulent condition. Provides an index of the virulence of a particular disease within a specific population. Number of deaths due to a disease / Number of cases of same disease x 100

Case Fatality Rate

Occurrence of more cases of disease than expected in a given area or among a specific group of people over a particular period of time

EPIDEMIC

Epidemic limited to localized increase in the incidence of disease

OUTBREAK

Aggregation of cases in a given area over a particular period without regard to whether the number of cases is more than expected

CLUSTER

An epidemic occurring over a widespread area and usually affecting a substantial proportion of the global population

Pandemic

``` Establish existence of an outbreak Verify the diagnosis Define a case Identify additional cases Perform descriptive epidemiology Develop and test hypothesis Reconsider hypothesis Perform additional studies if needed Implement control measures Communicate findings ```

Steps of an Outbreak Investigation

Determine if observed numbers exceed the expected level. In other words, need to confirm that an epidemic or outbreak or cluster has occurred.

Confirm the Existence of Epidemic, Outbreak or Cluster

Orient data in terms of time (when did outbreak occur?; timing of exposure and condition) Orient data in terms of place (where did outbreak occur?; spread? ) Orient data in terms of person (which persons were exposed, were affected?)

Perform Descriptive Epidemiology

Begins conceptually with disease and looks backward at prior exposures. Therefore, it is helpful in investigating the source of the outbreak. Useful when the population at risk is unknown

Case-Control Study

1. the endemic level 2. an ascending part 3. a plateau 4. a descending part, and, at times a secondary peak.

A typical epidemic curve may have four segments:

the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics

The social determinants of health

Defined as the presumptive identification of unrecognized disease or defects by the application of tests, examinations, or other procedures that can be applied rapidly.

Screening

The ability of a measuring instrument to give a true measure. Can be evaluated only if an accepted and independent method for confirming the test measurement exists. ``` Content validity Criterion-referenced Predictive Concurrent Construct validity ```

Validity

The ability of a measuring instrument to give consistent results on repeated trials. Repeated measurements Internal consistency Interjudge reliability

Reliability (or precision)

the degree of consistency among repeated measurements of the same individual on more than one occasion.

Repeated measurement reliability-

evaluates the degree of agreement or homogeneity within a questionnaire measure of an attitude, personal characteristic, or psychological attribute.

Internal consistency reliability-

reliability assessments derived from agreement among trained experts.

Interjudge reliability-

the ability of the test to identify correctly all screened individuals who actually have the disease (a/a+c)….True positives

Sensitivity

the ability of the test to identify only non-diseased individuals who actually do not have the disease (d/b+d)…..True negatives

Specificity

is the proportion of individuals screened positive by the test who actually have the disease (a/a+b).

Predictive value (+)

is the proportion of individuals screened negative by the test who do not have the disease (d/c+d).

Predictive value (-)

When the prevalence of a disease rises, the___________ rises, and the negative predictive value falls

positive predictive value

As ______ increases, specificity decreases

sensitivity

To improve ________, the cut point used to classify individuals as diseased should be moved farther in the range of the non-diseased

sensitivity

To improve ________, the cut point should be moved farther in the range typically associated with the disease.

specificity

Highly ______ tests are desirable for first screening

sensitive

Highly ______ tests desirable for more diagnostic screening

specific

A 95% confidence interval has a 0.95 (95 out of 100 times!) probability of containing the true population mean.

What is best interpretation of a 95% confidence interval?

is defined as the measure of the likelihood of rejecting false hypotheses where something could have occurred by chance. It is used when there is a normal distribution curve. It allows you to identify the most significant data, that is lying in the critical “tails”

Power (or probability or p level)

is the threshold value that we measure p values against. It tells us how extreme observed results must be in order to reject the null hypothesis of a significance test.

alpha

the researchers Rejected the null hypothesis, when they should have Accepted it. In other words the truth is they should not make a claim of association since it does not exist.

type 1 error

``` counseling and education clinical intervention long lasting protective intervention changing the context socioeconomic factors ```

CDC health impact pyramid from smallest impact to largest impact

exam 2 Flashcards

(77 cards)